It may not come as too much of a surprise to discover that there are generally more nurses working in major cities and metropolitan areas than there are in small towns and rural areas.

Some of the reasons for this situation may seem obvious, but other contributing factors may be less widely understood. What are the advantages of pursuing a career in nursing, and why are both supply and demand higher in busy urban centers compared to less densely populated regions?

The major metropolitan areas of the United States tend to be in the Northeast, the Southwest, or the Southern parts of the country. The New York Metropolitan Area, also known as the Tri-State Area, is the largest and one of the most populated urban areas in the world. It is certainly the major metropolitan area in the United States. Its nearest rival is Los Angeles on the West Coast, followed by Chicago, Houston, Phoenix, and Philadelphia. San Jose, San Diego, Dallas-Fort Worth, San Antonio, Austin, and Miami are also notable cities with substantial outlying urban areas.

The American heartland and Midwest are more sparsely populated, with smaller cities and small towns dominating. The distances between population centers are greater, and more land is given over to farming and agriculture. Nevertheless, over 80% of US citizens live in urban areas, and this trend continues to increase as cities and their outlying suburbs continue to grow.


The US nursing staff crisis

The United States is currently in the midst of an acute nursing staff shortage. A large percentage of the present nursing population is reaching retirement age, and not enough young nurses are entering the profession to replace them. Time Magazine reports that care is already being effectively rationed. with units across the country closing due to a lack of nurses available to provide treatment.

The crisis is made worse by an aging population that is living longer and therefore requiring more medical care on a regular basis. The pandemic undoubtedly exacerbated the problem, putting even more pressure on a health infrastructure that was already strained to the breaking point. Even now, when Covid-19 has receded to a manageable level, its effects are still being felt, with nurses suffering from prolonged burnout and many still not able to return to work.

A shortage of US nursing educators who are able to teach the next generation to the high standard required of today’s nursing workforce is also a major contributing factor. The result is a nursing market where demand far outstrips supply. According to the article cited above, it’s estimated that 200,000 new nurses are required every year between 2023 and 2026. The majority of that demand will be in densely populated metropolitan areas with large, world-class hospital facilities.

Also Read: How Nurses are Involved in Delivering Primary Care?

Higher salaries

Because there is such an overwhelming demand for nurses, the profession is able to command above-average salaries. Obviously, these vary from state to state and even from one workplace to another. It’s worth noting that, as you might expect, nurse practitioners earn substantially more than registered nurses, so it’s definitely worthwhile continuing your education so that you can qualify as an advanced nurse practitioner.

Texas Woman’s University offers a Family Nurse Practitioner (FNP) degree that can be completed fully online. With this degree, a graduate would be able to take full advantage of the high Nurse Practitioner salary in Texas. This course has the advantage of being compatible with working full-time as a registered nurse while you study for a more advanced and well-paid position in the future. 

Other benefits

Nurses’ salaries at every level are generally much higher in big cities than in rural areas. In part, this reflects the higher cost of living in urban centers. However, there are other benefits besides pay to attract nurses to the cities. Metropolitan areas typically have more training opportunities and more openings for specialized nursing staff than in smaller towns. Despite higher rents and basic costs, many young nurses are still drawn to the wealth of well-paid opportunities that working in an urban environment offers.

Because of the high level of demand for first-rate nurses, some hospitals offer generous sign-on bonuses for nurses with experience and good qualifications, as well as competitive salaries. Nurses also generally receive an impressive in-work benefits package, which may include health and life insurance, sick pay, guaranteed paid leave, pension schemes, childcare, wellness programs, and even reimbursement of tuition or certification fees.

Different factors

While there are some common factors contributing to the high number of nurses working in major metropolitan areas, different states and cities also have unique qualities that attract specific kinds of nurse practitioners. These are often related to the demographics of a metropolitan region and the faculties available there. Climate, geography, history, and state licensing laws can also play a part in determining why nurses may be drawn to a particular location.

The New York metropolitan area has both the highest number of nurses and the highest percentage of nurse practitioners in the country. Aside from the fact of the area’s huge overall population, which is obviously reflected in its nursing quota, the New York State Nurses’ Association is also highly active. By lobbying both state and city government on behalf of its members, the Association works to improve nurses’ working conditions and to create a healthier, lower-risk environment for all of the area’s inhabitants. The vibrant multi-ethnic and multicultural population of New York means that not only is there a great demand for culturally competent nurses, but there are also many potential nurses from diverse backgrounds ready to enter the profession each year.

Miami is a good example of a city where there is a high demand for nurses due to its elderly population. According to the US census bureau, 17.5% of Miami’s citizens are 65 or older, while nearly 35% of that cohort have a disability. As a popular retirement destination for well-off Americans, this Florida metropolis offers nursing practitioners specializing in gerontology a guaranteed position. 

Other cities with a significant elderly population include Mesa, Arizona; Albuquerque, New Mexico; and San Francisco, California. As the ratio of retired individuals to people of working age increases, the health industry will continue to enjoy rapid growth with many more job opportunities arising.

Job satisfaction

Whether you work in a big city, a small town, or an outlying rural area, nursing is a profession that arguably gives more job satisfaction than any other. Helping people feels good. We are empathic by nature and want to look after each other, to assist when our fellow human beings are in distress, and to alleviate suffering when we can. Nursing is one of the best career options for caring people. Training and working as a nurse gives you the knowledge, the means, and the infrastructure to provide care and healing in an effective and ongoing way.

Not all jobs feel meaningful, but nursing is one that definitely does. Having a career that gives meaning to your life is a blessing. The feeling that your individual existence is pointless or devoid of purpose is one of the major causes of unhappiness, but nurses rarely have cause to feel that way. Of course, they have bad days at work like everyone else, and not all patients make it through. But nurses always know that what they do matters and that they make a difference every day that they’re on shift.

Working with a team

Nurses working in metropolitan areas are more likely to find themselves part of a large, multi-disciplinary healthcare team. For many, this possibility is one of the reasons they’re drawn to work in a big city hospital rather than smaller facilities in a more rural region. Your team has your back. The challenges you’ll face as a nurse are so much more manageable when you have other hard-working, capable professionals by your side to support and encourage you.

Working as part of a large team also gives you more opportunities to specialize or learn new skills. People often come to big city hospitals to access treatment that isn’t available elsewhere. That also means that you can train to provide that treatment, perhaps working at the cutting edge of technology and medicine to offer ground-breaking services that improve and extend the quality of life.


One of the great advantages of nursing is being able to work on a flexible schedule. This means that you can take your time off in the week when you need it – for instance, to meet family responsibilities or to study. A 12-hour shift may be grueling, but it gives you a longer block of time off afterward. 

Working in a metropolitan area will likely give you more flexibility as there will be a greater number of staff members to cover all shifts. In a smalltown hospital with a smaller team there will be fewer options as to which shifts you can work, especially if one or more of your colleagues calls in sick. 

Flexibility also works both ways, and you need to be prepared to adjust your schedule or work overtime if needed. But you’ll be compensated for any inconvenience this causes and will always have the satisfaction of knowing that you are part of a team that gives 100% to get things done.


Nursing is one of the most trusted and respected professions in the US and around the world. Being able to take pride in your work and in your teammates is one of the best things about being a nurse. The support and appreciation you get, not only from patients and their families but also from the general public, is a great feeling as well.

Living and working in a big city with many amenities and an extensive population, you’ll be aware of the support and respect toward nurses all the time. Often this is expressed in ways that can make your life easier. Hospitality and retail businesses often offer discounts to nurses as a token of appreciation for the hard work that they do. While getting these discounts is never the primary motivation for becoming a nurse, it still feels good to see them offered, and it can make big city living that little bit more affordable.

Career opportunities

To be a nurse is to commit to lifelong learning, and there are always many ways to continue advancing your career. One of the great benefits of nursing is that there’s no reason to be stuck in one role for longer than you want to be. Opportunities for training, taking on more responsibilities, and earning a higher salary are ever-present, although you’ll need to be self-motivating and prepared to work hard in order to take advantage of them.

Once again, this is another situation in which working in a big city or major metropolitan area can help. It means that you’re more likely to have training facilities or nursing schools close at hand where you can learn new skills and earn higher qualifications. Of course, if you choose to study online you can become fully qualified wherever you are based. But once you’ve earned your degree or certificate, you’ll probably find more job opportunities in an urban environment than you would if you were out of town.

If you’re thinking about taking on a different specialization but aren’t sure if it’s right for you, then working in a city hospital may provide more opportunities to learn about the role before you decide. If you’re thinking about becoming a cardiovascular nurse, for instance, then you may be able to shadow someone from that department in your own hospital to find out what the job entails. A smaller hospital in a small town will probably not have so many different facilities that you can learn from.

Other settings

Nurses work in many other settings besides hospitals, including community health centers, schools, correctional facilities, care homes, and private businesses. You may choose to work in one of these throughout your career, or you might decide to try out several different settings during your working life. Another of the great advantages of being a nurse is that you’re not confined to one environment and can move around if you decide to.

Because big cities serve a larger population, they will generally have a wider choice of places where nurses can be employed. If you search online, you might be surprised at the number of different opportunities available. Providing home healthcare is one option, either for a single client or for a number of individuals in their own homes in different parts of the city. You might be able to fit this in around other work, or it might become the focus of your whole career.

Working with technology

Medicine is at the cutting edge of technology. Scientists and engineers are constantly working on new ways to make medical treatment safer, quicker, and more effective by using the technological tools at our disposal, from AI to robotics to new drug combinations and delivery systems. As a nurse you’ll get the opportunity to work with the very latest medical tech as it’s rolled out, and in some cases you’ll do a job that no one has ever done before.

This is another example of how working as a nurse in a big city beats nursing in a small town, as hospitals in major cities will almost always get the new technology first. Depending on how effective and vital the new equipment is, it will hopefully become available eventually in smaller hospitals and health centers as well. But as a nurse in a large metropolitan area, you’re more likely to have the chance of working on the front line of technological innovation and being a part of the future of healthcare as it happens.

Also Read: The Changing Role of Nurses and the Skills They Still Need to Succeed

Not just cities

Although this article has largely dealt with the advantages of being a nurse in a city or metropolitan area, it’s a fact that nursing is a rewarding and stimulating career wherever you work. Nurses are as urgently needed in small towns and rural regions as they are in the urban centers, and being a nurse in a less densely populated environment also has much to recommend it.

Nevertheless, there is a high growth rate for nursing roles in large metropolitan areas, and there are good reasons why this is happening. Metropolitan areas with high populations provide both supply and demand in terms of the healthcare profession. There are more people who need looking after, and there are more people able to step up and train for the job.

With urban centers providing more nursing schools, more places to work, and more developed infrastructure, it’s hard to see the flow of nurses drying up any time soon. People will continue to enter this most rewarding of professions, and we’ll continue to be grateful for them wherever we happen to live.


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